Changing the site of delivery of thrombolytic treatment for acute myocardial infarction from the coronary care unit to the emergency department greatly reduces door to needle time

Abstract

Objective-To quantify the change in door to needle time when delivery of thrombolytic treatment of acute myocardial infarction was changed from the coronary care unit to the emergency department. Design-A comparative observational study using prospectively collected data. Setting-Coronary care unit and emergency department of an Australian teaching hospital. Participants-89 patients receiving thrombolysis in coronary care unit between June 1994 and January 1996, and 100 patients treated in the emergency department between April 1997 and May 1998. Interventions-From April 1997, by agreement between cardiology and emergency medicine, all patients with acute myocardial infarction receiving thrombolysis were treated by emergency physicians in the emergency department. Main outcome measure-Door to needle time measured from time of arrival at the hospital to start of thrombolysis. Other outcomes included pain to needle time and mortality. Results-Median door to needle times were less for patients treated in the emergency department than in the coronary care unit (37 minutes, 95% confidence interval (CI) 33 to 44 v 80 minutes, 95% CI 70 to 89, respectively; p < 0.0001). Door to needle time was under 60 minutes in 83% of emergency department patients and 26% of coronary care unit patients (57% diVerence, 95% CI 45% to 69%; p < 0.0001). Median pain to needle time was less for emergency department patients than for coronary care unit patients (161 minutes, 95% CI 142 to 177 v 195 minutes, 95% CI 180 to 209; p = 0.004); times of less than 90 minutes occurred in 18% of emergency department patients v 1% of coronary care unit patients (17% diVerence, 95% CI 9% to 25%; p < 0.05). Overall mortality was similar in patients treated in the emergency department and the coronary care unit. Conclusions-With a collaborative interdepartmental approach, thrombolytic treatment of acute myocardial infarction was more rapid in the emergency department, without compromising patient safety. This should improve the outcome in patients with infarcts treated with thrombolytic agents.

A Review of Interventions and System Changes to Improve Time to Reperfusion for ST-Segment Elevation Myocardial Infarction

“…32,[37][38][39][40][41][42][43] Two studies were conducted at hospitals that continued to admit some patients to the cardiac care unit to receive thrombolytics, thus comparisons were both pre/post intervention analysis and between delivery time in the emergency department and the cardiac care unit. 37,38 Three studies also included an educational component to the intervention.…”

Emergency department thrombolysis improves door to needle times

“…[21][22][23][24] In this hospital, until April 2000, thrombolytic therapy was routinely given in CCU. The decision to change this policy to administration of thrombolytic therapy in the ED provided a valuable opportunity to prospectively assess the effect of this change on DTN in our hospital.…”

Moving cardiology to the front of the hospital

“…Although the difference was not significant, it is concerning to note that in the study by Hourigan and colleagues, only 8% of patients receiving thrombolytic treatment in the emergency department were randomised into clinical trials, compared with 11.2% of patients receiving treatment in the CCU 3. This may have been because of the number of trials being performed at the time of review.…”

“…The most successful approach has been to shift the administration of thrombolytic treatment from the coronary care unit (CCU) to the emergency department 2. In the study by Hourigan and colleagues which appeared in a recent issue of Heart ,3 the door to needle times of 100 patients treated by emergency physicians in the emergency department were prospectively compared with those of a historical group of 89 non-consecutive patients treated in the CCU between three years and 16 months previously. Not surprisingly, the door to needle times in the emergency department were much shorter than those in the CCU (37 v 80 minutes).…”